Provider Demographics
NPI:1639788029
Name:LADITAN, MOYOSOREOLUWA MORENIKE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:MOYOSOREOLUWA
Middle Name:MORENIKE
Last Name:LADITAN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
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Mailing Address - Street 1:1 CHILDRENS PL MSC 8116-0043-09
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2341
Mailing Address - Fax:314-454-2561
Practice Address - Street 1:1 CHILDRENS PL MSC 8116-0043-09
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2341
Practice Address - Fax:314-454-2561
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2024-03-13
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Provider Licenses
StateLicense IDTaxonomies
MI4351046257208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine